Provider Demographics
NPI:1225471477
Name:VILLANUEVA, NATHANIEL LEON (MD)
Entity Type:Individual
Prefix:DR
First Name:NATHANIEL
Middle Name:LEON
Last Name:VILLANUEVA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:71949 HIGHWAY 111 STE 300
Mailing Address - Street 2:
Mailing Address - City:RANCHO MIRAGE
Mailing Address - State:CA
Mailing Address - Zip Code:92270-4826
Mailing Address - Country:US
Mailing Address - Phone:310-248-6250
Mailing Address - Fax:
Practice Address - Street 1:465 N ROXBURY DR
Practice Address - Street 2:
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90210-4206
Practice Address - Country:US
Practice Address - Phone:310-248-6251
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-08
Last Update Date:2021-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA158807208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery